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(This Is The Fourth Segment In A Four Part Series)
The current system is not only burning a hole in our public deficit but adding an untenable amount to our unfunded liabilities. Meanwhile, both houses of congress are debating ideas that tinker with healthcare’s current paradigm: Allowing interstate exchange competition; transferring the federal penalty revenues from the federal government to the insurance companies; adding work requirements to Medicaid recipients; cutting the Medicaid budget related to Obamacare; incentivize providers for quality care; replacing the current subsidy program with tax credits for those not covered by an employer; removing the individual mandate; and expanding the scope and number of group health plans. One plan under consideration reduces health insurance premiums by removing benefits, such as: pregnancy/maternity; mental health/substance abuse; prescription drugs; emergency services; hospitalization; outpatient care; laboratory/diagnostic tests; preventative/wellness; pediatric care. Wow, I guess my question is: What’s the point of insurance if it doesn’t actually cover anything? None of these exclusions reduce healthcare costs, they simply shift the burden off of the insurance company and on to the patient. The idea of insurance is to spread the risk among the largest possible pool of subscribers, not to reduce the size of the pool. By increasing the pool, an insurer can afford to cover everything.
In other words, dancing around the edges of a bad system doesn’t change the fact that it is a bad system that requires a major overhaul!
We should remember that all groups lobbying congress are smart enough to make arguments that, on their face, sound as if they are in the public’s interest. In fact, all of these corporations and associations that represent healthcare entities, are only interested in advancing the interests and earnings of their corporations and/or their members. Conservative republicans in congress believe, on philosophical grounds, that a free market, private enterprise approach will solve our current healthcare crises. And everyone in congress is terrified of butting heads with the entrenched healthcare interests. But, the current systems at play have enjoyed government protections designed to enrich the players and feed their monopolistic tendencies. They bear very little resemblance to free enterprise as envisioned by Adam Smith.
Sorry conservatives, there is not a feasible free market approach that can even come close to fixing our convoluted, cobbled-up healthcare nightmare.
What We Should Do
First, rather than spending $70 billion per year on a hodgepodge of grants, programs and departmental research, we should create a federally funded patent pool. All pharmaceutical and medical device companies that want to sell products in the U.S. would be required to participate in pre-competitive R&D. (This is currently an experimental program at the Structural Genomics Consortium, Oxford University.) In addition to commonly shared therapeutic goals, all dead-end research would be compiled, if appropriate, re-examined and included in the consortium’s work-load. All participating companies would share in the research costs and investments. When drugs are approved for phase III trials, the commercial sponsors would be allowed to purchase the product rights and bring them to market. The idea is to reduce and in some cases, eliminate waste and redundancy. Under the current system, each drug company wants its competitors to waste time and resources. They are always looking for an edge to stay on top; hoping for the next drug monopoly. The goal of this plan is to create an infrastructure that fosters cooperation at the R&D stage, while still allowing companies to compete for the manufacturing and marketing of the final products. (Clay, Alexa and Phillips, Kyra Maya (2015) The Misfit Economy, Lessons in Creativity from Pirates, Hackers, Gangsters, and other Informal Entrepreneurs, Simon and Schuster Paperbacks, Simon and Schuster, Inc., New York, page 101)
Second, the prices paid for prescription drugs sold in the U.S. would be mandated to not exceed the average prices paid (for identical drugs) in all other approved countries.
Third, a commission would be established to oversee the Food and Drug Administration. This group would work closely with European Medicines Agency, Health Canada, Australia’s Therapeutic Goods Administration, Japan’s Pharmaceuticals and Medical Devices Agency (PMDA) and others to determine and approve drugs, which are approved in other countries but stalled by the FDA. It would also fast track generic drug company approvals.
Fourth, Congress should authorize Eminent Domain Condemnation for the patents of all drugs deemed life-saving or critical to the health and well-being of its citizens. This is a drastic legal tool and should be reserved for those drugs which serve relatively small markets and are outrageously priced. The research would become public domain. Companies would compete to manufacture and market the drugs, which of course would require FDA or commission approval. A legally mandated royalty would be paid to the current patent holders.
In this country, we believe in the freedom of choice and that the free enterprise system is the best way to achieve prosperity. We have always been wary of too much government control, and after Hitler, Stalin, Mussolini, and Mao we have 20th century evidence to back up the American way of life. However, as a country, we have also concluded that government can be a force for good. I’ll give you some examples: We believe that everyone has a right to drive on our roads; send and receive mail; be protected from foreign adversaries; and participate in public education. It is just as American to believe that everyone has an equal right to adequate healthcare.
Aside from the United States, every other civilized country has looked at healthcare and decided that only a singular, unified system will work. And I agree. Given the purchasing power and clout of the United States government, we should have the lowest healthcare costs per capita, not the highest… And with a unified, single payer system, everyone in the country could be covered and as a nation we would not be paying a penny more! Nationalizing health insurance, would increase federal expenditures, but that isn’t the most important factor. The question is: will less wealth be drained nationally under the current system or under a national health insurance program. The evidence overwhelmingly is that our current system costs the country far more than if we were to switch to a unified national system.

(This is the Second Segment In A Four Part Series)
The healthcare system that Obama and other liberals preferred was a single payer expansion of Medicare that covered everyone. However, Obama learned a valuable lesson from previous democratic presidents who had attempted to take-on the various healthcare interests, and failed. Being a pragmatist, he realized that any change in healthcare would require the buy-in of all major players: the pharmaceutical, hospital and health insurance industries; and of course, the powerful American Medical Association.
If Obama could have garnered the support of all democrats, even without a single republican vote, he could have passed any bill he desired. But, the democrats from red and purple states were representing voters that were less liberal and therefore more skeptical of a system run by the government, so the compromise plan that he settled on was a nationalized version of Mitt Romney’s Massachusetts program, including sweeteners that lobbyists believed would increase their revenues and profits.
The Affordable Care Act was never a shoe-in. Even with the support of lobbyists and moderates, the bill was never very popular with the public and barely squeaked through congress.
Obama’s main goal was to decrease the huge number of uninsured Americans, not to fix the costly and fragmented systems and organizations that controlled healthcare. To accomplish this mission, he reinvigorated individual health insurance by setting up a state to state network of health insurance exchanges and then mandated that everyone in the country be covered under some form of government approved health plan. This was a necessary ingredient, because to induce insurance companies to include preexisting conditions there needed to be a huge pool of participants. Children could continue under their parent’s policy up to age 26. Anyone choosing not to participate were to pay a special mandated penalty (or as the Supreme Court ruled, a tax). Low income participants qualified for graduated federal subsidies; paid for through a series of new or increased taxes to help pay the cost of insurance premiums. There was also an expansion of Medicaid payments to the states.
The result has been mixed. Many of the provisions are very popular and about 17 million more Americans are now covered by health insurance than before Obamacare. And the rate of increase in healthcare costs has been slightly lower in recent years, however, the fundamental flaws that existed before, have not gone away. While healthcare expenditures are increasing at about 5.5%, healthcare premiums for individual plans are increasing at a rate of about 25%! Although, taxpayers may groan, almost 85% of plans purchased through the various marketplaces receive federal subsidies. This is to help participants pay for otherwise unaffordable health insurance premiums. Of course, to qualify their incomes must be below federally determined thresholds, the lower your income, the greater the subsidy.
I admire Obama’s goal of providing everyone with health insurance, however, all he accomplished was to load more and more people onto an incredibly expensive and inefficient system. The poor may benefit, but at a huge and growing cost to the federal government, which is already stretched to the breaking point. And many who don’t qualify for subsidies won’t participate. And finally, if insurers can’t cover expenses, then one by one they will drop out of the various individual marketplaces.
If we compare the health outcomes with other developed countries, we still have a long way to go:
Costs
There are many reasons for the big increases in individual healthcare plans. First, Obamacare did very little to halt healthcare inflation, and in fact contributed to the huge rise in pharmaceutical prices. This is because, under the law, Medicare is banned from purchasing generic drugs, only name brand products; and second, Medicare is also banned from negotiating drug prices, which has allowed the pharmaceutical industry to raise retail prices to obscene levels — for Medicare and the uninsured — while offering attractive discounts to big group insurers. Second, many young and healthy Americans have found it cheaper to incur the penalty, rather than pay the high cost of individual health insurance plans. And this trend will likely increase as premiums purchased through exchanges continue to soar. Thus, with fewer participants in the pool, premiums will rise even further. Third, Obamacare created a new and untested model for insurance company actuaries and executives. They simply overestimated the actual number of participants and underestimated the loss ratio and the costs of participating in the various exchanges. The result has been huge losses for smaller insurance companies that primarily focused on individual plans; and huge profits for the big insurance companies that focused on group plans. Many big companies were smart enough to see the “writing on the wall” and have dropped out of the exchanges, refusing to participate in the unprofitable individual healthcare markets. And fourth, by adding 17 million newly insured consumers there was logically more demand for hospital services, clinic visits and prescription drugs. In 2015 we spent $3.2 trillion on healthcare, almost $10,000 per person in the United States, representing 17.8% of our Gross Domestic Product. The fact that healthcare as a percent of GDP keeps rising means that, as a nation, a greater percentage of our national resources are diverted from other sectors of the economy.
Healthcare in America is collapsing under its own weight. The administrative costs (including services that are ultimately written off as bad debts) are enormously inefficient, cumbersome and must serve a myriad of requirements by federal and state governments; as well as numerous insurance plans; including the coding and pricing of countless medical services and prescriptions. Nothing is easy or uniform. The price of every service and product is based on thousands of separate negotiations. And of course, if you are not included in a plan (or covered by Medicaid) then you pay the retail, listed price for everything. To give you some comparisons: French hospitals have about 67% fewer administrative personnel than the U.S.; Our health insurance industry spends 20 cents on every dollar for non-medical costs, France spends a nickel. In America, we spend about $3.2 trillion dollars on healthcare. 20% of that figure comes to $640 billion dollars. If we could bring down our non-medical costs to 5% that would be an annual savings of $512 billion or over the next ten years: $5.1 trillion!
Aside from administration, other drivers of increasing costs are the American Medical Association (AMA) and drug prices. First of all, as a nation, we need a huge increase in the number of qualified doctors and other medical professionals. On the other hand, the AMA wants to greatly limit the number of doctors to keep their member’s salaries high. General practitioners have felt the squeeze between higher operating costs, including high medical malpractice insurance and the ability to raise prices. Many have found it in their best interests to form group practices, own their own labs,hire their own technicians and replace MD’s or DO’s with Physicians Assistants; doctors, therefore become more managers than practitioners, resulting in poorer care for patients. There is also a logical tendency to over-refer their patients for testing and lab-work. Many of these tests may be justifiable and reimbursable, but not medically necessary or even desirable. Every time there is a new study that questions the value of some test or procedure, the AMA immediately refutes the study. Unfortunately, then, every visit to your doctor becomes a game to see how much money can be extracted from the insurance company. Still the general practice doctors are not making a fortune and many are struggling. The specialists, however, are making a fortune and their prices continue to rise well above the rate of inflation. It is not surprising then, that in England about 60% of medical doctors are general practitioners, but in the United States about 65% are specialists.
My experience with a Urologist provides a good example. When I was about 60, my primary care physician discovered that I had a slightly enlarged prostate and my Prostate-specific Antigen or PSA was high enough to cause concern (In England PSA tests are rarely given, as they are not considered a reliable test for prostate cancer screening). Therefore, I was referred to a Urologist, who started asking questions about erectile dysfunction and how many trips I made to the bathroom at night. He then scheduled an ultrasound for my prostate, which apparently wasn’t conclusive, so he then scheduled a biopsy, which showed no cancer. In the meantime, he also scheduled an ultrasound of my bladder to determine how much fluid remained after urination and then scheduled a separate test to determine the strength of my urine flow. These tests resulted in the prescription for a drug, the side effects of which were worse than the minor annoyance of a couple of trips to the bathroom at night. Two years later I was diagnosed with colon cancer. As part of the surgery, a Urologist was needed to insert stents. A pre-op consultation was required in the doctor’s office (the same office that I had visited a couple of years earlier), at which time the Urologist asked about my PSA, my nighttime bathroom habits and if I experienced erectile dysfunction. After finishing with his initiated Q and A, he got up to leave. I had to stop him, sit him back down and ask: “What are stents and why are they important to my procedure?”

But I feel that having some sort of mandatory deposit into IRAs would be a better investment for everyone, rather than the "maybe" payouts of future health benefits?
Thoughts?
I'll have to write more about this as I gather my thoughts.

"Allow the direct purchase of subsidized health insurance plans through the health insurers own websites."
Source cited: HealthCare.gov Plan B Fix
This simple action would open the flood gates to the new health insurance plans that are currently being blocked because of the HealthCare.gov website problems.

So there are a couple of things I need progressives to explain to me.
1. If the point of the affordable care act is to insure those that don't have insurance why in the shit do I have to participate in it?
2. If I should choose not to participate why is it ok to fine me for choosing not to use a "Service".
3. If I should fail to pay the fine that is levied against me for choosing not to use a service I didn't want in the first place what should my punishment be? Prison? Theft of my money through bank account seizure? Killed?
4. How is forcing somebody to buy a service through threat of violence or theft of funds constitute freedom?
5. Explain to me how forcing poor people to pay a fine if they do not buy insurance is helping them get insurance?
6. Why in the world do progressives want to expand the power of the federal government to fine an individual for not participating in a service they don't want? Surely even you can see that while right now you are getting what you want that is a good thing but down the road it could become problematic for you.
Isn't forcing somebody to comply with your will even when you have the majority on your side something you see as immoral?

Dear Topic,
I feel that the American Health Care System is in a rut. If you take a look at the current problems in health care; too many people do not have insurance, too many plans are tricky and only cover certain illness and injury, the cost is out of control (dr wages, operational cost, cost of insurance, etc), plans are confusing, too many companies competing for public accounts, cost is too spread out amoungst plans and companies who provide, good care is hard to come by, there is a shortage of qualified doctors, too many people are on government options, insurance companies make too much profit while denying people of care because of policies and contracts, too many people getting hurt are not american citizens and have no insurance or legal way of obtaining insurance, etc, etc, etc.
With the new found Obamacare, Americans will be forced to get insurance and his basic idea is that if the citizens have insurance they will not be denied care. His idea to make it a tax, if you fail to obtain insurance Im guessing is a way to encourage people. It includes ideas to force insurance companies into unneeded contracts and also reduces the amonts of profit corporations can make from citizens. etc.
In my idea the system would improve from;
- A tax of 2-3% on citizens to payroll accounts - towards providing essential emergency care (once admited to a hospital coverage is discussed or applied for).
- For their to be 'Primary Insurance Providers' would mean that its still manditory to have insurance but the whole state pays roughly into the same place, gathers money together and are covered for 'essential' health care and that it would be chieper then spreading the comunities money amongst profiting corporations
- For their to be trade programs for damaged medical equipment - so that certain hospitals can face no repair charges and help them obtain equipment from old n damaged ones
- For the wages and salaries of Doctors to not be outrageous amounts in the budget of hospitals / negotiations
- For 'Primary Insurance Providers' to be designated by the government in which every citizens pays - to limit competitions between insurance companies, to put public funding in the same place, to limit regulations to a few companies, to open policy's by bringing more money into the system and limit the number of companies providing
- Bringing down cost of operations at hospitals with - manufacteuring repeatedly used or bought equipment, negotiations on salaries, a cost of medical operations layout - then reserch into how to bring down cost, etc.
In all I feel that the American Health Care System could use some improvments and in its current state is mabye a little 'ill' itself, and it could use some criticing to improve it.
thanks for your time
Bill to The Patient
Proposition: 3-5 Primary Insurance holders amongst each state. Obligations from citizens to pay towards their insuance (Insurance cost per state /. Population). State Coverage through Primary Providers & made up of funding from all the state’s citizens – and in return providing essential health care.
I feel that the Health Care System in America could use some improvements. Obama has outlined his plan to reform health care and I feel that I have idea’s that would help the current health care system and might be able to utalize the baseline of Obama’s plan – which is, to help society be able to obtain medical care through insurance, because the system cost too much for regular individuals to afford. I feel that the current market for law to be the way Obama would like is not compatable, beacause of the wide variety in options and competition and the amount required for coverage.
Obama’s plan to force insurance companies into clients, to cheapen cost of insurance, and to make insurance manditory will cause insurance companies to come into extra spending and more patients to cover while having to many options dividing down the public money. If it is manditory to have insurance when there are so many options for coverage that means, companies will still have a small group of insuries to collect from while having to pay large amounts for their clients.
Health Care System (future)
A tax to american citizens, for coverage of emergency medical care
Primary providers, designated, for each state – assesing (population vs. cost of care = insurance)
Lowering cost of health care (with ideas like – more salary paid employement, trade & repair programs for expensive medical equipment, negotiations on how much the private system is allowed to charge for treatments (i.e. cost of operation – price display), Obama’s plan to increase productivity of medi-care, manufacteuring hospital goods that are frequently used or constantly bought from overseas, etc.)
Providing for the public (i.e. pointing them to insurance as a way to cover high cost of treatment, limiting options for the public to get the citizens money in the same place, Giving people assurance that if they need to go to a hospital they will be treated – because they are a citizen and contribute to the insurance reform) understanding that care will and should be provided
Citizens may understand my point when: they understand that insurance is a must have to be able to afford the cost of care, they see insurance more directed at paying towards the care you receive – rather than; a just incase, when they understand that if all their money went in the same place it would be easier to afford, when they see that making primary providers makes it easier to navigate and regulate, when they understand that since there is more money going into the same ‘pool’ people wont be turned away for care because of cost, and when they understand that the community prepares together.
The American Health Care System is in some ways out of control – as in; too many people are not covered; the ones that are covered are only covered for certain illnesses because of contracts; the amount it cost to do procedure at hospitals is extrodinary in cases, people are now with Obama Care in some ways forced to get insurance of some kind when it is costly as a monthly expense, there are to many providers – which leads to problems like; patient cost limits and un-covered treatments.. etc..
Primary Insurance providers would be a good option to limit the competion and get the citizens payments in the same general area. Citizens would be covered for their illness to the best of care and cost would be less of an issue to a company when the states money is collected together.
If the society pays a medium to primary providers who ‘cover’ the citizens – and in return bills are looked after for health care coverage by the primary provides for the state, companies would have a much easier time paying bills with such a large number of payments.
This would allow for simpilar law and more direct at just a few companies who we can work with to sucure the system – policys, costs displays, bills, etc. It would also allow for a large sum raised amongst the community and allow an open market for coverage (what people need pertaining to medical care) – meaning that a citizen will not get rejected for treatment that may save their life – beacause, coverage is made up of a bill to the citizens.
Studyies would insume – how much the state’s insurance providers currently spend on average on health care coverage each month over 5 years – the idea being that number is needed by the collective community to cover its society for health care. Citizens pay a medium for State Insurance.
Also included in my plan, is a tax to american citizens from paychecks that gaurentee’s its citizens stabalization and emergency medical care – when admited to a hospital coverage will then be discussed with a provider and any social assistance that would be available.
People may blam taxes and cost hikes as an issue, in my opinion, it would allow the federal government to start a new tax at the same time fight issues of emergency medical care cost and people that have improper coverage. It would also help with saving for financial needs during unpredicted circumstances for the public. If you pay for a tax for emergency care when you get hurt – as a citizen, you would in-turn not have financial burdens during times of being hurt and visiting an emergency room – as well as, save you from being obligated into a policy for coverage during times of being hurt.
With this being the plan to calculate state insurance vs. population and pay down the cost each month through everyones participations with Primary Providers. This would also allow insurance to be provided through limited but already running ‘companies’ – allowing each senate to mandate still – but, privatly, and for coverage to be more open to what citizens ‘come down with’. It would all come down to how much it would cost on average for the medical coverage for the state vs. population.
People may veiw my opinion negatively because they are afraid of big changes to an already tareing system and I feel that if regular people understood that their insurance now may be only covering certain illnesses or that if their money was all in the same place it would be easier to afford on a bussines stand point. If they understood that coverage would be more open to the type of illnesses covered because the fund is larger and built together by the community. How much easier it would be to regulate for less insurance companies with open policies. Ane if the public put their money in the same place and crunched the numbers it may be easier to afford together rather then all spread out.
If this idea was seriously looked at the first and probibly loudest problem would be the insurance companies who would be cut out of the system and “their public rights for free market as a Corporate of America” – the best I can say is they can market share on the system if they want or they can be sub-providers for one of the primary insurers or they can compete in different ways of insurance (dental, theoroputic, medication, etc..) – but the best thing would be to designate Primary Providers to oversea the public money so that it is easier and more easily affordable.
Also, while this being the plan talk could ensume about my other idea’s to improve the cost and system on the medical side (being Hospitals/etc.)
Imputting more salaried Doctor’s required at larger facilities
Giving a tax to Americans to cover any citizen for emergency medical care. Upon needing additional care coverage will be discussed – or applied for, or a bill. During communication with patients talks about finacial assistance can also be available.
Expanding more government owned hospitals where wages, salaries, & operation are at our cost, taking note on how hospitals in major cities are also business.
Finding ways to manufacteur cheaper equipment for hopitals.
A trade and repair program for expensive hospital equipment.
Negotiations on Doctor wages & salaries.
Long term care facilities to look closer into the more major care & science development of re-peatative or expensive/special treatment, and to take higher cost out of general care.
Manufacteuring of repeatedly used medical equipment and high cost item’s
A sheet of rough estimates of procedures and a ‘ diagnoses’ of cost J lol (to have rough idea’s for insurance providers and medi-care and to be analyzed to reduce costs)
Bring cost down of hydro, by helping incourage electricity upgrades
If the States at all reflects towards this community, the Health Care System is a major part of the society from students to employee’s and to training facilities amongst the community. The system needs improvements that will reflect on the system over time and hopefully increasing its productivity. Making it easier for those who find there way into needing medical care and for the hospitals to be able to afford there daily duties easier and also for insurance companies to narrow the system and spread out the cost amongst the community – and provide to those in need.
We also need for people who are ‘doing well’ in the science around medical care to be properly funded and those who take advantage of the system to know and learn better. A few stories have been on Cnn about fraud – I just want for the people who are doing the good work to be rewarded, for people who need care - obtain help and treatment, and for the system to be ‘mathematicaly’ affordable.
Thanks for your time